HIStalk Practice Interviews Halee Fischer-Wright, MD President and CEO, MGMA

Halee Fischer-Wright, MD is president and CEO of MGMA.

You’ve been with MGMA since 2015. What did you set out to accomplish, and how have your goals for the organization changed?

As I was being recruited in 2015, I recognized that MGMA – a remarkable organization with a fantastic brand – was really struggling to find its relevance in the healthcare world that had changed pretty dramatically in the five to seven years prior to my arrival. It’s one of those things where you can’t keep doing the same thing and expect the same results in a world that has undergone a dramatic shift. I knew I had to create a vision when I came in. I also knew the transition for a 90 year-old organization was going to take more than your standard 90 to 180 days. It’s really going to be between a three- and seven-year process.

The first thing that I focused on was actually finding relevance. Where is MGMA relevant in this day and age? That day and age was in March of 2015. I really spent the first year digging into that. Aside from that, there were other operational issues related to how you manage and operate a non-profit association and bring it up to speed with other industries. What I set out to accomplish that first year was to identify where our relevance is and really clean up the operations of the organization. I think we did an outstanding job with that.

Now, as we move into my third year, the goals have shifted. Year three is really looking at opportunities now that we’re clear on what our vision is, which is that MGMA wants to move from being the organization that reports on group medical practice to leading group medical practice. To do that, we have to shift some of our business functions, and we have to really change how we do business, which is, in full transparency, parallel to the growth processes going on right now at almost every other organization within healthcare. That’s what we’re focused on right now.

Let’s shift gears a bit and discuss MGMA membership, particularly small and independent practices. What do you perceive their biggest challenges to be, especially as they relate to technology?

According to our statistics, somewhere in the neighborhood of 40 percent of practices are in the small to medium-sized practice range, defined as less than nine providers. That’s quite a few practices across the country. We’re talking about practices that aren’t just in rural areas. These can be practices in urban areas as well. As we saw between 2010 to about 2015, there was a lot of consolidation with healthcare systems purchasing the small to medium practices. That has slowed down over the last two years. In fact, we’ve seen divestiture staring to occur. That begs the question, why do healthcare systems decide to divest practices and what do practices struggle with? I would say there are two really big things that practices struggle with, and they go hand-in-hand. First, it is the regulatory reporting burden and the shift of the payer landscape as far as how do physicians report on quality.

The other part is related to EHRs and the promise that it would make practices more efficient, and allow them to deliver higher-quality medicine and spend more time with their patients. We’ve actually seen them have the opposite effect. EHRs, because they’re not engineered specifically for the end-user, end up being really a business application. Because of that, it’s really interfered with the practice of the art of medicine. We’re seeing physicians becoming increasingly burnt out and patients becoming increasingly less satisfied. We’re now at a crisis point where physicians aren’t happy and patients aren’t happy. Our federal regulators can’t afford to pay any more money. Something needs to change. That really is the reason that I wrote the book Back to Balance.

 Are you going to be signing copies of it at the conference?

Of course I am!

Speaking of the conference (which kicks off on Sunday, October 8), how will help physician attendees address those issues? 

There are a couple of ways we’re doing that. First of all, I think our advocacy office is second to none. There’s no healthcare association that has better insight into how healthcare regulations affect the day-to-day operations of a practice. What the pros are. What the cons are. How to work within the regulations to still deliver high-quality, patient-centered care. We’ll be doing quite a few sessions with our governmental affairs office in DC. That’s number one. Those tend to be some of our most popular offerings at annual conference.

We’re also offering sessions on practice operations. There’s a lot that we can do in medical practice to streamline operations to make patients and physicians much more satisfied. If you don’t ever get the opportunity to leave your practice and think about how things should be different, you don’t get the opportunity to see how others can do it. We’re offering that. We have several educational tracks at our annual conference to really offer those insights that allow practices to bring something tangible home and put it into place. That’s probably what I’m the most proud of. We’ll also offer several CME sessions that really link the business of medicine to clinical practice as well.

Did you have any input into getting actress Viola Davis as a keynote speaker?

Yes. It’s really interesting. The topic of women in leadership has been a really hot topic over the last 18 months regardless of what your political ideology is. I think, in healthcare, we’re a bit down in the mouth. We’re really feeling victimized. There’s so much uncertainty. To bring in someone who can talk about how their circumstances really would have set them up to be unsuccessful, and even to be a victim, and how she triumphed in the face of great adversity, is really important for an organization like ours. I hope our attendees should really hear her story and come away inspired to move things forward, and to bring change into their own lives, even in a small way.

Circling back to technology, what has MGMA members excited?

Programs and software developed by end users are where people are focusing. We’re coming to a point in our technology that we’re moving towards interoperability. We believe that, within the next couple of years, we’ll see the government really regulate that interoperability, which will take care of a lot of the headaches that we currently experience. Where we have not seen a lot of improvement is in end-user design. We’re now seeing other players from other industries, i.e. Apple, starting to stick their toe into healthcare. That elegance of design focus and end-user focus, I think, is going to transform the relationship of technology in healthcare. I think it will require someone from outside of our industry to bring that expertise.

One of the things I talk a lot about is the fact that with healthcare, we expect incremental change. We’re happy with 2 percent, 3 percent, 4 percent. It really requires disruptive innovation. Who best to lead that than our partners in innovation in the Silicon Valley to really point out to us where we can be disrupted for the benefit of all? I do believe that’s coming.

Do you think companies like Apple and Amazon will either develop their own EHRs or partner with existing EHR vendors?

I’m going to say something completely controversial, and I’ll get pummeled for it. The aspiration of the EHR is fantastic. The application of the EHR has not lived up to anybody’s expectations. I’d like to see alternatives to an EHR. In a cloud-based system with sharing of data, maybe even some blockchain technology, it looks very different than what we’ve come to know as kind of a bread-and-butter EHR. That’s where I feel the disruption needs to occur. It’s something that we haven’t even envisioned yet that would come through and just, basically, everyone would say, “Yes, this is what we’re missing.”

Honestly, I think about my iPod. I didn’t know I needed an iPod, but since I got one I couldn’t live without it. Speaking as someone who had well over a thousand CDs, the idea of condensing all that into something that fit in the palm of my hand … At first, I thought this is ridiculous and it can’t be done. In all fairness, I can’t imagine what my life would be like without it. I think we’re going to have that same experience with EHRs and some of the new technology that’s being developed.

MGMA recently released its annual practice operations survey. Did any of the results surprise you?

I think they will surprise some patients. According to our survey, the wait time for patients has improved. I think, if you speak to any patient, that does not feel like the case. It’s actually down an average of 20 minutes between the waiting area and the exam room. The other thing is that, in scheduling, physician-owned practices see patients sooner than hospital-owned practices. I think that’s really interesting. That’s an insight that could be really useful for patients who are trying to decide how to choose their care.

What’s even more shocking are the results around patient portals. I went to a conference in 2005 where they talked all about patient portals and how they would give patients the ability to take their personal records with them anywhere they go. It hasn’t happened. Only 30 percent of patients who visit hospital-owned practices use the portal. Whereas, if you’re in a small physician practice, less than 10 percent use portals. The function that people like the most is online payments and communicating with providers. Less than 5 percent are using it to schedule appointments, which is really probably its biggest strength.

The other thing I found really interesting are the patient satisfaction results. Three-quarters of practices measure patient satisfaction. That’s quite a few, but I don’t see that commensurate with improvement in patient satisfaction. Clearly, the axiom of you get what you measure is not actually occurring in measuring patient satisfaction. Only about 27 percent of patients that go to a practice are satisfied with their experience.

How can physicians act on those survey results, especially when it comes to online scheduling adoption and patient satisfaction?

In the book Back to Balance, I point out that just because we measure it in healthcare doesn’t mean we actually do anything about it. I actually practiced medicine this way. I practiced for 19 years. The question I found myself asking was, if this test isn’t going to cause me to change what I’m doing already, I’m not going to order the test. In the same way, I would tell people, if you’re not going to do anything about patient satisfaction, stop measuring it. The irony in this is, let’s talk about quality measures in medical practice. According to our data, every physician, on average, spends about $37,000 measuring quality. Not to improve things. They just spend it to report it.

A better way to look at it is to ask physicians, what are you doing that is not adding value? I think a great place to start with things like this are patient satisfaction surveys or portals. They are tangible and there isn’t a lot of judgment around them. These are just things we have. Then physicians need to ask themselves if they’re doing anything with these results. If not, then stop doing it. Where can they invest their energy and effort that will move the bar on patient satisfaction or on enhancing portal usage? Those are the crucial things that I don’t think physicians have ever had the time to consider. Physicians are so burdened with all the things we need to do that we haven’t had the time to lift our heads up and ask those questions. If we stop doing things that don’t add value, we’ll find the time.

Finally, what advice do you have for conference attendees? Any tips and tricks for getting the most out of their experience?

I would advise people to really map out their strategy and be realistic. It’s one thing to take a look at our website and map out 14 sessions to attend. What I would ask people is, are you really going to attend 14 sessions over three days? If you’re not, then seek out the ones that you feel you can attend, engage in, and bring something back home to put in to practice. I think there’s always that balance between personal development and enhancing the practice. I’d ask people to really consider before they attend what they want to do for personal development, and then what they can bring back to their practice to really prove the value of attending the conference.

Contacts

Jenn, Mr. H, Lorre

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5 Questions With Raymond Cox, MD Executive Director, Volunteers in Medicine Clinic

Raymond Cox, MD is the executive director of the Volunteers in Medicine Clinic in Hilton Head, SC. Founded in 1993, the clinic provides medical, dental, and mental health services for the working poor on on Hilton Head and Dafuskie Islands. As the name suggests, its staff are all volunteers. Many, like Cox, have come to work at the clinic after official retirement. Today, 600 retired physicians, nurses, social workers, interpreters, dentists, and chiropractors work together to conduct over 30,000 clinic visits. The Hilton Head location has helped to launch a nationwide network of 87 VIM clinics in 28 states.

What types of healthcare technology does the clinic use? Have healthcare technology companies been willing to donate software, hardware, services, etc.?

We use EMD’s EHR. Progressive Technology and Tech Soup – both local companies – have donated services.

How have you seen that technology impact patient access and outcomes?

The technology we use has improved our data access.

What healthcare technologies would you like to see implemented in the clinic?

I’d like to have better access to data integration, as much of our clinical records are scanned. We just signed a contract for tele-psychiatry services.

The clinic’s website mentions that it serves as the flagship clinic for similar facilities across the country. Have you had a hand in helping set up other VIM clinics?

My involvement has been limited, as most of clinic start-up activity has been handled by the VIM Institute in Burlington, VT.

Has the network of VIM clinics thought about pooling patient data for population health/value-based care programs?

We are in the early discussion of data pooling, but we do conduct an annual survey that provides some data.

What do you feel to be VIM’s biggest challenge today? Could technology help to make that situation less burdensome?

Our biggest challenge is money. Technology could certainly help us fundraise by giving us the ability to provide compelling data to donors.

Contacts

Jenn, Mr. H, Lorre

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HIStalk Practice Interviews AMA President David Barbe, MD

Family physician David Barbe, MD is president of the American Medical Association. After 15 years in independent practice, he merged his practice with the 650-physician Mercy health system in Springfield, MO, where he is now VP of regional operations.

Tell me about yourself and the organization.

It’s really an exciting time to be president of the AMA with all that is going on in healthcare. The AMA is the largest and oldest national physician organization. We have over 220,000 members including students and residents – practicing physicians from all over the country in every specialty. It’s a way that we can bring the voice of physicians together so that we can, in fact, speak with one voice and articulate those issues that are most important for physicians and our patients.

You spent a good part of your early career as an independent physician before moving to hospital employment. How have you seen technology improve medicine? And on the flip side, how have you seen it take away from the art of medicine?

Once upon a time, when I first entered practice 34 years ago, everything was paper – prescriptions were paper and the chart was paper. Some physicians made pretty good paper charts and others didn’t. The EHR came into being really barely more than 10 years ago. I think most people think it’s been with us forever, but widespread adoption of the EHR is only about 10 years old. There were EHRs before that, but very few physicians in the country were using them. I think most of us looked at the EHR with great hope and anticipation. We understood the potential and the promise of the EHR, but for many physicians, and I would say even most physicians, the EHR has become a very significant source of frustration. It is the first or the second thing that physicians list when they talk about dissatisfaction with the way their practices are going and what stresses them.

While the EHR does continue to show promise, we are a long way from being in the perfect world with our EHRs. The AMA issued a white paper a couple of years ago. The authoring task force brought in practicing physicians from all over the country to talk about what it would take to make the EHR better. We came up with things that range from doing a better job of supporting team-based care to doing a better job of promoting care coordination. Reducing workload in terms of providing more effective decision support at the time of care, data liquidity, and interoperability continue to be a big problem. If a patient sees another physician and they’re on a different EHR than I am, that information just doesn’t transfer back and forth smoothly. We have a lot of opportunity for improvement.

The AMA believes that getting a practicing physician’s voice into that development and refinement process is critical. We work really hard with the vendors to try to encourage them to talk to practicing physicians to take to heart what we’re telling them about what does not work for us, and design that into the next update and next generation of the EHR.

Speaking of physician frustrations with EHRs, how do you plan on helping the AMA work to reduce physician burnout?

Most of the studies on this show that burnout comes from external factors. It’s things like the stresses of the EHR, workload and productivity, uncertainty regarding payment methods, the challenges of documenting and reporting the various quality metrics and Meaningful Use metrics that we are being asked now to report on. All of those things interfere with the doctor-patient relationship at some level. We did a study just last year that shows physicians spend twice as much time during their work day on the EHR and what I’ll call paperwork-related activities as they spend with their patients. The AMA has devoted a lot of resources to this. Physicians consider themselves evidence-based. The AMA has taken a lot of effort to gather information about what would really help.

We write that down into three big categories. One is, how do we change the external environment? How do we then give physicians tools to better cope with what we have to deal with? There’s still going to be that part of us that has to strive for more satisfaction, a better work-life balance, and adapting better to those external stressors. AMA has put together a suite of products called Steps Forward that contains 40 modules ranging from how to be more efficient at reauthorizing prescriptions to how to conduct a better meeting within your group practice, and everything in between. We have a lot of information in there about how to prepare your practice for quality reporting that has come down the pike under MACRA. It’s a broad suite of products.

We also want to change the practice environment. We want to reduce the burden, for instance, of prior authorizations. The AMA has put together a white paper with 21 recommendations of how the paperwork burden and a pre-authorization burden can be reduced and yet not compromise some of the things, if you will, that the insurance companies feel like they need to accomplish with their prior authorization forms. We have been successful. We’re seeing insurance companies discontinue requirements for prior authorizations in different markets. That will have a very meaningful improvement in a physician’s life. We found that it takes an average physician, or his or her staff, 16 hours a week to do prior authorizations. That’s two full work days for someone to do prior authorizations that add very little, if any, value to the care we give. In fact, they often delay care. Ninety percent of physicians said that care has been delayed due to the time it takes to process and get approval on a prior authorization.

The AMA also seems to focusing its resources on the opioid epidemic and educating physicians about best prescribing practices. What role do you see technology playing in stemming this tide?

We believe that the PDMP – a good, well-functioning PDMP – is critical to helping physicians help their patients through this very difficult issue of opioid misuse and what it often leads to, which is substance abuse. The good PDMPs, and I’ll define what I mean by that, they have clearly shown that they reduce prescribing. We see evidence of this in fewer overdoses and fewer deaths as opioid prescribing goes down.

Good PDMPs are products that have real-time information. If I see a patient on a given day and PDMP data is a month old, then I don’t know if they went to two other doctors over the course of that past month. It needs to be in near real-time. It needs to be easy to access as part of the physician’s natural workflow. If you have to get out of your EHR, log in to a PDMP, and go through several security steps – and all that takes five minutes to get there – that physician is just not going to use that. That is not an efficient use of their time even though when they get there, the information may be good. It needs to be a natural part of the workflow, easily incorporated and accessed through their EHR, and contain timely information. If you make it easy, physicians want this information. They know how important it is. We need to continue to work toward making each of these as easy as possible to use. That is a huge step.

In terms of other technologies, there are some that are developing out there that will help patients more closely regulate their own use. If I prescribe a bottle of 100 pills to a patient, I don’t know if they take them in one week or two weeks, or if it really lasted the whole month that it was intended to. There are dispensing systems out there in which the medication is dispensed out on a daily basis so that it makes it less possible for a patient to misuse the medication that they’re given. Things like that are also on the rise. I expect that some innovative physician developers will come up with other easy to use, effective apps that would help patients and physicians do a better job at monitoring and tracking medication use.

Let’s back up to PDMPs for just a second. Are there any states that you’ve heard of that are using them in really effective ways?

In terms of good examples, there is some sharing of information between state PDMPs, but quite honestly, these things often end up getting hung up in state legislatures. That slows down our ability to be nimble and to make rapid cycle improvements in PDMP effectiveness. That also requires state-to-state collaboration, the sharing of information across state lines. In my home state of Missouri, we have two large metropolitan areas that are right on the state line – St. Louis on the east and Kansas City on the west. If you live in Illinois and you come to Missouri to see a doctor, the doctor can’t access the Illinois PDMP; same thing on the other side of the state. Again, opening these up, making the information available across state lines, certainly in regional areas, would really be a giant step forward.

What are your thoughts on the black eye Missouri has created for itself in terms of standing up a statewide PDMP?

The fact that we haven’t been able to get a PDMP approved has been a real sore spot for physicians in the state. Again, sometimes the problem rests with the state legislature. That has been the case in Missouri. It demonstrates, however, how determined physicians and other governmental agencies are at getting this information into the hands of prescribers. You may be aware that in St. Louis, St. Louis County has actually developed a PDMP that they are willing to share with other counties around the state. That is really gaining traction as a workaround to a statewide PDMP. I think it will actually not only help us in this intermediate term, but will actually move the discussion at the state level forward in a more effective way.

Speaking of state legislation, how are you seeing the political climate in Washington affect AMA members? Are they heartened that HHS Secretary Tom Price, MD comes from a physician background? Happy that the ACA is still in place?

We always think it is important that a physician leads agencies like HHS and even CMS. We would prefer to see physicians in all of those roles, especially physicians that have had practice experience. Someone who has been in the trenches and understands what it’s like to work in an EHR, what the burden and the hassle of prior authorizations is like. A physician that has that background is in a better position to understand and address those problems. We hope the current administration will address regulatory relief, making it easier to practice medicine, taking less time away from our patients, and giving us more time for the highest and best use of a physician’s training. We do believe that the current administration is more interested in that. We have begun to see movement in that.

We also know that the Republican Congress seems to be a little more favorable toward regulatory relief. It was just a couple of weeks ago that I met with Chairman Brady of the House Ways and Means Committee to discuss regulatory relief and how could they change things to make it easier for physicians to do their job. I am cautiously optimistic that we are going to see improvement.

The other big area, of course, is health system reform and where we stand with regard to potential changes in the ACA. The AMA believes that significant gains were made under it, including Medicaid expansion, and insurance exchanges and subsidies to help patients with low and moderate incomes purchase insurance were very beneficial. We saw 20 million people get insurance that did not have it prior to the ACA. That is a good thing.

We also believe that there are some areas in which the ACA is falling short or not working. Affordability is one of those. Even with the subsidies, there are some low-income individuals that have difficulty affording coverage. The other thing is the high deductibles in some of those plans. If you’re low income, even if you’ve been able to afford the premium, you still may not really have access to care because of the high deductible.

The stabilization of the insurance markets also needs urgent attention. You may know that over a third of the counties in this country have only one offering in the insurance exchange. That’s really no choice at all if you value patient choice, which the AMA does. One insurance company is not choice. There are many counties that now have no offerings in the exchange. If we were to have this conversation six months ago, 97 out of 114 counties in Missouri had only one offering on the exchange. I’m sad to say that a couple of months ago, an insurance company pulled out of the Kansas City area and has left 24 Missouri counties now with no insurance offering. This action is by the insurance company. I’m not defending them. They have simply not found the insurance exchanges to be profitable. They have been losing money in many areas of the country.

In order to get the insurance companies back in, the AMA would like to see the cost sharing reduction program stabilized and effectively reinstituted so that insurance companies can offset some of the premium cost to low-income individuals. We’d also like to see a reinsurance-type program such that if insurance company losses are excessive, there is a reinsurance to limit their losses. It’s through those types of programs that we can entice some of the insurance companies back into these markets where there’s no offering in the exchanges. We believe that competition will actually help bring down premium prices, and certainly improve choice and availability for patients.

What health technology has you most excited in terms of its ability to help improve access and outcomes?

The AMA is very interested in what I’ll generically call telehealth. It’s often referred to as telemedicine, but I think it is much broader than that. It improves the ability to link physicians and patients in ways that we’ve not been able to do before. We now have the technology available to link up, let’s say, a specialist in an urban area or an academic center with patients in a more rural area. For me, in Missouri, that really makes a difference. In my day job as a physician executive with my health system, I oversee five small hospitals and 75 physician practices – some of which are 100 miles away from urban or tertiary care centers. We are already employing technologies like e-hospitalist where we have a hospitalist or an intensivist in an urban area that can provide backup and assistance to both nurses and physicians in a smaller rural hospital. It allows us to sometimes keep patients in a rural hospital that would otherwise have to have been transferred, sometimes hours away to a tertiary care center. Things like that really make a difference in patient care.

We believe that we’ve just scratched the surface. To that end, the AMA is involved in many activities to help accelerate the development of and adoption of new technologies – all the way from simple limited scope technologies like apps on a mobile device all the way up to how we make the EHR better. As I said earlier, we really want to insert the voice and the experience of the practicing physician into this development process earlier. To that end, for instance, the AMA participates in innovation center in Chicago called Matter, where we have the opportunity for practicing physicians to come in and meet with innovators and discuss their ideas. We have a mock exam room in which we can actually try to see how these innovations would play out in a real-world practice. We believe doing that will help make the final products more usable.

What frustrates physicians as much as anything is that these new technologies may be developed in a vacuum with regard to practicing physician input. They’re developed and rolled out to doctors with the promise of being the next best thing. But I look at it and say, “What practicing physician ever thought this would work for them?" In many cases, in spite of best efforts, they just haven’t engaged with practicing physicians. We really think that there’s a lot of opportunity out there for new technology and physicians are eager to adapt. We’re ready to do things that will help patient care. It’s just that much of technology at this point has been as much of a curse as a blessing.

Do you have any final thoughts?

I think it is important for physicians to be involved and engaged. We talked about physician burnout. When physicians get burned out, they tend to disengage. This is the wrong time for that. We need every physician to be in there, to be active in their groups, to be active in their hospitals if they have a hospital part of their practice. To be active in physician organizations like their county and state medical societies. That’s how we change difficult practice environments – through physician involvement and engagement. The AMA wants to help that happen. I encourage physicians to stay connected and engaged, and to not withdraw. That’s how we’re going to make things better.

Contacts

Jenn, Mr. H, Lorre

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HIStalk Practice Interviews Geeta Nayyar, MD Chief Healthcare & Innovation Officer, Femwell Group Health

Geeta Nayyar, MD is chief healthcare and innovation officer at Femwell Group Health in Miami.

Tell me about yourself and the organization.

I am the chief healthcare and innovation officer for TopLine MD and Femwell Group Health, one of the largest management services organizations in the state of Florida. We manage about 500 practices in the state, primarily focused on women’s health and primary care. As a board-certified practicing physician who specializes in rheumatology, I maintain an active practice, serve on the medical school faculty at Florida International University and George Washington University and host "Topline MD TV," Florida’s premiere medical digital news channel.

I’ve always loved science and people, and I wanted to make a difference in people’s lives. The best part about my current position is that I am able to make an impact beyond just one-one-one patient care. I can help influence changes in the industry that could potentially impact thousands of people in a positive way for better care and better outcomes, and that is supremely gratifying.

Femwell decided to roll out patient engagement technology from HealthGrid several months ago. What prompted that decision?

Given the paradigm shift in healthcare and a more consumer-driven and value-based care model, we were looking for a strategic partner and, after a thorough and competitive vetting process, determined that HealthGrid was the right partner for us to help us achieve a higher level of patient engagement and better outcomes. We need 50 percent of patients to have a mobile connection with their providers to get meaningful outcomes via patient engagement technologies. HealthGrid is the only company we found that had 50-70 percent of their customers’ patients engaging on their mobile devices to review their care summaries and adhere to their care plans. In addition, the company also guaranteed attestation for all patient engagement MU/MIPS measures.

When patients are engaged in their care – which means meeting them where they are on their mobile devices – they have better outcomes. HealthGrid has a health management engine with patient engagement built into it, which ensures quality continuum of care in their healthcare journey. Physicians also see and appreciate the measurable ROI afforded by such a comprehensive system that harnesses the power of the value-based care model.

Femwell rolled out telemedicine services last year. How has adoption been? How has that service impacted access and outcomes?

Our adoption of telemedicine services continues to grow. We have seen a significant growth across specialties and across groups. This in part is due to the ease of access for both physicians and patients. Telemedicine has allowed our physicians and patients to connect after-hours and on weekends, when needed. Patients are comforted knowing their own doctor has adopted new technologies to enhance their care. It’s an extension of the brick-and-mortar physician offices, in the palm of their hands.

With the adoption of telemedicine services, TopLine MD has seen better outcomes for patients simply by enhancing their continuum of care and lessening the need for patients to visit other physicians in emergency rooms or urgent care centers.

What unique challenges do OB/GYN practices face when it comes to selecting and implementing health IT?

OB/GYN practices have specific challenges just by the nature of care they need to deliver. Many appointments need to be done face-to-face because physical exams are required for proper care. As far as the patient engagement component of maternity care is concerned, telemedicine and interactive patient engagement tools allow physicians and patients to stay connected, and can help alleviate stress and anxiety of an expectant mom. Tools tailored specifically for young families on the go, such as accessing a physician’s note for school officials, without having to visit the school or the physician’s office, is just one of the ways real patient engagement tools make a difference in the everyday lives of families.

Aside from technology, what are the top two or three challenges your physicians are facing today? How is Femwell helping them work through these?

Physicians at TopLine MD face the same challenges as most. Physicians want to be physicians and the challenges surrounding the business of healthcare, including processes, marketing, and policies, should not affect the precious eight-10 minute patient visits with a physician. We offer innovative foundational support for physician practices, including robust patient engagement technology that enables physicians to focus on the patient.

Getting back to technology, what’s next for Femwell physicians?

The technology platforms at Femwell have evolved and telehealth capabilities are increasing. Femwell is planning to further expand by increasing utilization up to 10 times through connecting patient engagement technologies to telehealth. We’re also looking forward to strengthening the partnership with HealthGrid through data analytics and leveraging strategies for reporting to various regulatory agencies, enabling it to excel in the value-based care world..

Do you have any final thoughts?

This is just the beginning for Femwell. It has proven to be a leader in helping physician practices succeed by working with strategic partners such as HealthGrid to facilitate meaningful communication with patients in this new paradigm in healthcare. We believe having the right tech partners at the table will ensure the best delivery model of healthcare possible.

Contacts

Jenn, Mr. H, Lorre

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HIStalk Practice Interviews Daphne Bascom, MD SVP, Community Integrated Health, YMCA of Greater Kansas City

Daphne Bascom, MD is SVP of community integrated health at YMCA of Greater Kansas City in Missouri.

Tell me about yourself and the organization.

I am a physician by training, board certified in otolaryngology, and head and neck surgery. I trained out of the University of Pittsburgh and Oregon Health Sciences University, and have been in Kansas City now for about five years. I completed my fellowship in microvascular reconstruction at Case Western University, then left there and joined Cerner for the first time. I then worked for Ascension Health for a short time and then Cleveland Clinic. I spent six years rolling out Epic at Cleveland Clinic. During that time I was able to work as part of their wellness institute. I went back to Cerner about five years ago and was most recently CMO.

I joined the Y in January of 2017. It’s probably easier to call me the medical director for health and wellness; that is my role today. I am the first physician employed at the association level – the first local doc. The YMCA of Greater Kansas City is actually an association of 14 different YMCA centers that are both in Kansas and Missouri. We have about a million visits to our Y annually, and are the largest provider of childcare in Missouri and Kansas.

I’ve read that you’re also a competitive body builder. How did you become involved with that?

Around the time I turned 40 I treated myself to some personal training, and my trainer was a professional figure competitor. She was preparing some competitors for competition and I thought it looked fun, so I decided to start competing. I earned my professional card six or seven years after I started competing. While I’ve always been a gym junkie, it wasn’t until I turned 40 that I really started to understand how important nutrition was, and how to really wed health and wellness together.

What prompted you to make the switch fro the vendor world to the Y?

I was already a member, and had been on their board for two years. I’d watched this Y as they started to make the transition from what we call “swim and gym” to really starting to engage with the community. I introduced the Y to Cerner because I saw a huge opportunity, given what they were doing, to integrate population health strategies into what the Y was doing. This was while I was still at Cerner. I also started facilitating conversations between the Y and Truman Medical Center, which is our safety net hospital, and then I pulled in the university. It was one of the most fascinating set of conversations I’d heard in years because they were throwing to the wind what we had done conventionally, asking, "How do we do this differently? How do we better leverage our community partnerships?" I got excited about doing the work when I was on the Cerner side. When the Y posted for a clinical leader, I threw my hat into the ring and was fortunate to get the position.

How has your health IT experience already started to help inform your role at the Y?

On top of my Cerner and Epic experience, the YMCA started an Athenahealth deployment in January. Any YMCA that delivers our diabetes prevention program is using Athenahealth, which is going to be our standardized EHR across all of the Ys nationwide. I’m getting a little bit of exposure to Athena now and it’s really exciting.

The technology connection is probably at multiple levels. I think there’s a community connection where we can improve how we are using e-referral processes, and improve decision support so that providers can perhaps be prompted to refer patients to community services in the context of their workflow. I’d also like to get rid of the paper trail by having more electronic processes to refer patients into the Y, or for me to refer patients to a provider. And – this is my dream, especially living in Kansas City and seeing what Cerner is doing with Healthy Intent – having the potential for a true community health record.

If all of this data were above our individual organizations in the cloud, you could tie in clinical needs with community needs and then add in social determinants of health, which isn’t done that well today in the EHR. That could help create a better picture and help people understand what it is they really need from the health side, the care side, and the community side.

We’re also in the process of rolling out a mobile platform for delivering evidence-based programs. We partner with a company called Noom. We just started our first diabetes prevention program on smartphones.

Given that the Y isn’t a conventional healthcare provider, how does it plan on using the EHR?

The diabetes prevention program is delivered by trained lifestyle coaches, who we are training to use the EHR to almost as if they were an ancillary care provider. Every one of their classes becomes a schedule for them, the provider. All of the participants in their classes will be on their schedule as if they were seeing people in clinics. They are required to enter the participant’s weight, their activity, if they are completing their food log. We also have them doing "billing" just to document their participation – if it’s their first session, their 10th session – so that we can also report on their progress. It’s the same Athena that everyone uses. It’s a little nuanced.

The funny thing is I hear the exact same complaints from the coaches that I hear from the physicians with regard to the technology: “It’s too many clicks. It takes me too long.” The great thing is that it’s standard, so regardless of whether you’re in Atlanta or Kansas City, you will have the same experience and the same data will be collected. At the national level, the Y is beginning to aggregate the data across all of our facilities so that we can begin to look at our outcomes. One of the primary motivators is that we want to be able to participate in Medicare reimbursement starting in 2018. We needed a certified EHR in order to be able to submit those claims.

All of the Ys have their NPI and we’re in the process of working on NPIs for our coaches. From an organizational change perspective it’s huge, because YMCAs historically have not really had to be HIPAA-compliant. Now, one of my responsibilities is as our privacy officer, and getting everyone HIPAA-trained and HIPAA-certified, and putting in place the policies and procedures to make sure that we are compliant. It’s been a massive organizational change effort, and I have to applaud the national office for taking this on.

We’re also working on e-referrals. The three primary EHRs that we’re working with in Kansas City are Cerner, Epic, and Athena. I can’t directly receive a referral from any of them or send a note back to them. We’re hoping to turn on Athena Communicator, which will give us some capability to do Athena to Athena communication. We’re exploring Direct messaging, although we know some of the challenge with Direct nationally in terms of adoption and usage. And then we’re also part of an initiative out of the Million Hearts program that is interested in exploring the same things. There are a few different organizations trying to figure this out.

Are you thinking about adding telemedicine?

That’s a great question. The answer is yes. I just don’t have the answer for who the provider will be. We just built a new Y in one of our underserved communities called Linwood. In partnership with Truman Medical Center, we’re going to build a clinic that’s physically attached to the Y. It’s not a new model; there are multiple Ys that already have integrated rehab and physical therapy or other clinical services. But as part of that, we are going to have an e-visit room, and so we’re looking at what that may be and who may provide that. I’m advocating that it should not be seen as just a clinical visit, but that it could be a care team visit. If I needed to have a provider on a line along with a coach, along with the patient … we want to make sure that the technology can scale and have a care team concept – not just a patient-to-provider concept.

Are you already thinking about connecting to a local or regional HIE?

Yes. We met with the Kansas Department of Health several weeks ago to see if we can help them with some of their rural communities. They wanted to know, “Can we send this health data to the Kansas HIE?” I’ve also talked with the Missouri Primary Care Association. We have three HIEs in Missouri. I think the challenge from the YMCA’s perspective will be point-to-point in every state. It’s going to be very expensive. And will it be sustainable?

I would love to have all of this go up into some big, massive cloud, but again I’m probably just dreaming. In Missouri I have to decide, “Do I send the data to all three HIEs or do I bet on one being sustainable? Will I make people mad if I choose one and not the other?” There are some politics involved. Nationally, I don’t know if funding and maintaining all of those connections is going to be the Y’s long-term strategy.

You mentioned working with a public health agency. What social determinants of health are you incorporating into your community-integrated health program?

As many as possible. And I know that’s not an answer. One of the things I’ve been doing for the past four months is making introductions around the community, both to share what the Y is doing and then also to better understand what other resources are available. I’ve also been visiting all of our Ys to understand what are the important non-swim-and-gym elements of healthcare that we can address with appropriate services from the Y or our partners. We’re already working with Truman, KU, and food trucks. There are significant areas of Kansas City that are food deserts.

With our Million Hearts Program, the Dept. of Health in Missouri has agreed to help us organize transportation for patients that may want to participate in our blood pressure self-monitoring program. If they are recommended by their provider to be part of a BPSM program and transportation is an obstacle, can we work with the health department to schedule a van or Uber to get them to meet with our Healthy Heart ambassadors. From a language and literacy perspective, our Y is piloting an English as a second language program. We’re helping address literacy within members of our community. These programs are actually taught by community volunteers, not even employees at the Y.

What are your goals for these programs? What are your aspirations when it comes to continuing to build them out?

I think the first goal is for both the community and the healthcare community to know that these programs are available. Communication and program availability is key, and more importantly, as well as making our programs part of the clinical care workflow. I’d love to enable providers to either refer patients and/or to see data from participation in these programs. Another goal is to scale the programs across more of Kansas City and Missouri and Kansas. Kansas and Missouri are not the healthiest states. I need to be able to scale the programs and deliver them to more members of the community. Those aren’t just YMCA members. We deliver programs in churches, schools, and to employers. To do that, part of it has to be having the resources to fund our coaches.

I think a lot of what I’m going to be leveraging technology for is to meet people where they are. You may not be able to come into a Y physically, but if you can meet with a YMCA coach on your smartphone or iPad, then we can help you maximize your health potential with whatever resources are available. The last part would be for the Y to become a trusted and respected member of the community care team. It takes a village to be healthy. In a 15- or 20-minute clinic visit, there’s no provider that’s going to be able to address all of the key factors that make people well or help keep them healthy. It may be that they don’t have electricity, or that they don’t have great access to food. They may not have an ID that allows them to get their health insurance on the exchange.

We want to continue to extend what we consider to be health and care to be inclusive of our community resources, and to make those resources available to people as they need them. We want to make sure that the provider community has immediate access to us when it’s appropriate so that we can help extend what they’re doing to keep people healthy.

Contacts

Jenn, Mr. H, Lorre

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